Insuring the Citizens of "X"

(Normally, I'm not very political here. My intention today is not primarily to put forth a political position, but to encourage a civil, sensible conversation. No doubt the ruminations of my mythical king, and my thoughts that follow, leave much out. That's what the comment box is for. If the comments are civil, and based on sound thinking--not only emotion--I'll be glad to post them even if I disagree. After all there is the remote possibility that I could be wrong.)

Let us suppose that I am King of the Kingdom of X. The latest population census indicates that there are ten citizens in my kingdom. Six of my citizens are married. Two lovely couples are still childless. The other husband and wife have grown children who have gone out of our kingdom. They live in Y, Z, or somewhere. There is a widow and widower, lovely older folk. I won't be surprised to be asked to preside over another wedding. The grand matriarch of the kingdom is one-hundred and seventeen. She gave up mountain climbing last year. After she returns from a bike trek to the neighboring kingdoms, she will return to her job as librarian of the Kingdom. Some folk tell me she is getting to be a bit forgetful. Perhaps in five or ten years we'll need to build a nursing home for her.
Then there is Jack the Tenth. He drinks, a lot. He insists on riding his big Howard Davidson motorcycle without wearing a helmet. When he goes down the road there is more smoke that comes from his cigarette than from his bike. Sometimes he smokes some weed that he buys in the Kingdom of Colorado. He says it makes his rides prettier. The kingdom just bought its first ambulance, just in case.
As a benevolent sovereign I want to make sure that my subjects are well cared for, so I'm going to provide what the Kingdom of C calls Universal health care. My kingdom isn't rich--we are still making payments on that ambulance--so I have to figure out a way to pay for it.
My Royal Accountant tells me that we could easily cover eight of our citizens for $10/month. If they all pay. If we knew for sure that Sarah the Matriarch would die in her sleep at home, we could do the same for her, but, there is that nursing home. Then there is Jack the 10th.
"I'm consulting with Count Adrenaline of the Kingdom of Chaos, to come up with an estimate for him. It ain't gonna be cheap or pretty, though."
Bob, one of the young husbands in my kingdom is a sharp lad. He approached me the other day. He

wants to start an insurance company. He might even sell policies in Y & Z. He said for folk like Sam & Sally, the other young couple, he could provide complete coverage for $8/month including agreeing to pay for costs related to the birth of their child, which is about a sure thing. While we were talking the smell of burnt fuel and tobacco wafted through the window, accompanied by the roar of the Howie.
"Him? . . . wouldn't touch him with a ten-foot pencil, no matter how sharp."

OK, my fairy-tale has gone far enough. In the real world not only are the numbers of citizens far greater, the complexity of issues is exponentially greater. Having said that, though, can't we just admit that there are several elephants in the room.

• Some people are a far greater risk than others. Much of that divide lines up with the divide of old and young.
• If everyone is going to be insured, the healthy, at least for a time, are going to have to put more in the system, probably much more, than they take out.
• If there is a government mandate--that means the government can punish you if you don't participate--then those who choose a healthy lifestyle are forced to subsidize those who live foolishfully, or dare I say it, "evil-ly."
• For an insurance company to say I can insure these healthy, young people for $X, but if I include these unhealthy old people it will cost $X x Y, is not necessarily cruel or a sign of callousness. It is reality.
• If there is a blanket mandate that anyone can sign up for insurance at anytime without consideration for pre-existing conditions, how is that different than allowing someone to buy a car insurance policy ten minutes after the wreck?
  Compassion and common sense have to have an intelligent conversation on this one.
• Whether the coverage is single-payer, or as it used to be called "socialized medicine," or provided by businesses, the reality is, it is still a form of insurance. Somehow sufficient money must be collected to pay for what is spent for the care people need. Deciding whether government or business can do it best is a conversation that needs to take place. 
• There is a limit to how much we can squeeze health-care providers. If fixing plumbing in bathrooms pays better than fixing the plumbing in our chests, guess which career the best and brightest will choose.

Our new President has already begun to "dismantle" the Affordable Care Act. The rhetoric is about to get deeper than the pile of bills one gets after a major surgery. It's important not only that we play nice, but that our conversation be governed by clear thinking.